China launched what it claims is the first purpose-built hospital ship (Type 920) in the world in 2007, stirring a considerable amount of international speculation regarding the Chinese Navy's future roles and missions. The use of hospital ships in non-military operations by the U.S. Navy has long been associated with the concept of soft power. While soft power consists of such areas as diplomacy and economic assistance, it is also inclusive of elements of communication. Particularly in the case of humanitarian assistance and disaster relief (HA/DR) missions, the ability to convey a message to "relieve … conditions such as human pain, disease, hunger…” especially with the use of military doctors, can be extremely powerful [1]. In spite of the prominent role that Chinese hospital ships increasingly play in the Chinese Navy's effort to shape international perception of the Peoples' Liberation Army Navy (PLAN), a detailed examination of the evolution of the Chinese hospital ship program and its strategic implications has been lacking in discussion of the PLAN's growing naval capabilities.

Given China's growing maritime HA/DR capabilities, there are now more opportunities for cooperation between the United States and China in HA/DR. During the PLAN's Qingdao Fleet Review in April 2009, Chief of Naval Operations Admiral Roughead was invited to tour the Daishan Dao. Subsequently, Admiral Roughead extended an invitation for Chinese participation in a U.S. HA/DR mission. In June 2009, four Chinese visited the USNS Comfort in Colombia during Continuing Promise 2009. Chinese visitors composed a mix of civilian and military, and their attendance during the HA mission demonstrated the first step toward afloat medical cooperation between the United States and China. This was rather significant for the overall maritime and strategic relationship as it demonstrated cooperation despite the USNS Impeccable incident in March 2009. The United States will again embark on an HA mission, this time to Asia during Pacific Partnership 2010, providing another potential opportunity for U.S.-China cooperation in maritime HA/DR.

Conceptual Origins in South China Sea Skirmishes

Some observers have claimed that the development of this new ship was a response to China's inability to respond with maritime HA/DR during the 2005 Tsunami relief efforts. That explanation, however, ignores the fact that the 10,000-ton 866 Daishan Dao was under construction as early as May 2004 [2]. Moreover, China has been deploying hospital ships since the early 1980s in preparation for combat-related missions [3].

China’s first-generation hospital ships, the Nankang-class, were converted from Qiongsha-class attack transport ships and entered the fleet in the early 1980s. Chinese analysts assert that the skirmishes in the Paracels and the Spratlys, 1974 and 1976 respectively, were the main motivating factor driving the development of first-generation Chinese hospital ships. The Nankang-class hospital ships are deployed in the South Sea Fleet and their placement reflects the purpose for which they were designed. According to Qu Zhaowei: “Given the scale of an amphibious campaign to land on the islands in the South China Sea would not be too large, the two Nankang ships would prove sufficient to meet the need” [4].

The distance of these naval skirmishes from mainland China was enough to warrant the need for a hospital ship. Lacking a hospital ship at the time (1970s) of these maritime conflicts, Chinese soldiers and sailors who were wounded were not able to receive treatment offshore in the immediate zone of conflict. The primary historical reason for building hospital ships has been to create the ability to treat wounded military personnel during combat at some distance from one’s home shores. Up until that time, all hospital ships built by other countries had been conversions from other ships. The Chinese response to the disputes in the Spratlys and Paracels of converting other hulls into hospital ships followed the trend of international hospital ship conversions at the time.

Interim Experimentation with Defense Mobilization

Commissioned in January 1997, the Shichang was built as a multi-role aviation training ship. The second-generation Chinese hospital ship is actually referred to as a “national defense mobilization ship” (guofang dongyuan jian). Mobilization refers to the ability to mobilize civilian assets for military use. When medical modules, painted white with red crosses, are placed on the Shichang, rather than cargo containers, the ship effectively becomes a hospital ship. It is likely that dual-use platforms such as U.S. Navy LPDs that have used modular hospitals on deck influenced the design of the Shichang. Canada (ships forthcoming) and Germany also have similar hospital ships.

The Shichang was actually built in response to the Chinese observation of the Falklands War according to Chinese sources [5]. During that conflict, the SS Uganda was converted by the British from an educational cruise liner and was used as a hospital ship. One Chinese author reflects: “The experience of the [Falklands War] illustrates that the fighting of a war is closely linked to the issue of the mobilization of transport assets” [6]. As recently as 2008, China mentioned its desire to have a clearly defined national defense mobilization system that is compatible and commensurate with its national security needs [7].

A Purpose-Built, Dedicated Hospital Ship

According to the People’s Daily, the 866 Daishan Dao is the world’s first purpose-built hospital ship (People’s Daily Online, November 3, 2008). Jane’s Fighting Ships lists the Russian hospital ship, Yensei, as the first purpose-built hospital ship. The Daishan Dao belongs to the East Sea Fleet and was commissioned on 22 December 2008. The exterior of the ship is painted white along the guidelines of the Geneva Convention and has six red crosses. It has a helicopter hangar with the capacity to hold 1-2 helicopters along with a helicopter pad. The indigenously built Z-8 large shipborne helicopter has been photographed operating with the Daishan Dao. Pictures also show that there are six lifeboats. The vessel has a medical staff of 600 along with a crew of 200 to sail the ship. In addition, it is said to have over 500 beds with 8 surgical operating rooms and the capacity to “accommodate 40 major surgeries a day – about as many as a large hospital in Beijing” (People’s Daily Online, March 24, 2009). Xinhua News Agency indicates: “This ship makes China one of the few countries in the world to possess long range medical rescue capabilities. A large hospital ship is considered an important division of a modern navy” [8].

Yu Dapeng is the captain of the 866 that held its first exercise in mid-March 2009 (People’s Daily Online, March 24, 2009) followed by exercises in June and September. On October 20, 2009 the Daishan Dao departed Shanghai on a 39-day, 5,400 nm humanitarian assistance training mission (HATM) carrying nearly 100 civilian and military medical experts (PLA Daily, November 30, 2009). China’s HATM took it to many stops among the islands and reefs in the South China Sea to include visiting many military outposts. China’s HATM shows the first indication of the ship’s potential soft power.

Nevertheless, Chinese analysts assert unequivocally that support to large-scale amphibious warfare was the primary reason for building the Daishan Dao. They state that the Chinese hospital ship can “integrate and participate in amphibious attack squadrons.” They go on to say that: “Once war erupts, the Daishan Dao and Shichang or other modular hospital ships, anchored at a certain distance, can prepare to admit the injured” [9].

Very little is known about the fourth-generation hospital ship, vessel 865, except for a few photographs that have surfaced recently [10]. The ship appears to be a container ship that has been refitted with medical modular units much the same as the Shichang. The 865 is a dual-use ship; it can be used as a container ship or a hospital ship. It is possible that this type of ship was designed in response to the fact that the maintenance and repair of a purpose-built hospital ship, especially in peacetime, is expensive [11].

According to Jane’s Fighting Ships, vessel 865 is the largest modularized hospital ship in the world (4xs larger) with over 100 modules and weighing in at 30,000 tons. A recent photograph in Renmin Haijun actually shows two modularized hospital ships being assembled side-by-side, suggesting that the use of medical modules for container ships could be significant in scale [12].

The Impact of Hospital Ship Missions on Maritime Strategy

While assisting in wartime is its first responsibility, the use of a hospital ship in non-war environments such as HA/DR has increased dramatically over the past few years. The exercise of soft power with hospital ships has gained increased importance after HA/DR was designated as one of the U.S. Navy’s core interests in A Cooperative Strategy for 21st Century Sea Power. Thus, while the Chinese hospital ship program and the impressive Daishan Dao in particular was not the result of the 2005 Tsunami relief effort, it is likely that higher profiles for these vessels in the aftermath of that event and other major USN maritime HA/DR efforts are having an impact on Chinese strategy in this domain. Indeed, the need to improve China's HA/DR support capacity was identified in the country's 2006 Defence White Paper. Moreover, a PLA Navy captain recently announced at an international conference in Vancouver that China would soon begin HA/DR missions deploying the new hospital ship beyond East Asian waters [13]. Hospital ships have demonstrated an enormous capacity to produce a range of positive and highly significant effects and this is clearly recognized in Beijing.